Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma

Ann Esquivel, William W. Busse, Agustin Calatroni, Alkis G. Togias, Kristine G. Grindle, Yury A. Bochkov, Rebecca S. Gruchalla, Meyer Kattan, Carolyn M. Kercsmar, G. Khurana Hershey, Haejin Kim, Petra Lebeau, Andrew H. Liu, Stanley J. Szefler, Stephen J. Teach, Joseph B. West, Jeremy Wildfire, Jaqueline A. Pongracic, James E. Gern

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Rationale: Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal. Objectives: To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma. Methods: In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression. Measurements and Main Results: RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, 20.77 to 20.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84). Conclusions: In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility toRVinfections and illness.

Original languageEnglish (US)
Pages (from-to)985-992
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume196
Issue number8
DOIs
StatePublished - Oct 15 2017

Fingerprint

Rhinovirus
Asthma
Infection
Immunoglobulin E
Confidence Intervals
Virus Shedding
Therapeutics
Omalizumab
Virology
Censuses
Mucus
Nose
Odds Ratio
Guidelines
Inflammation

Keywords

  • Asthma
  • IgE
  • Omalizumab
  • Rhinovirus

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Esquivel, A., Busse, W. W., Calatroni, A., Togias, A. G., Grindle, K. G., Bochkov, Y. A., ... Gern, J. E. (2017). Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma. American Journal of Respiratory and Critical Care Medicine, 196(8), 985-992. https://doi.org/10.1164/rccm.201701-0120OC

Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma. / Esquivel, Ann; Busse, William W.; Calatroni, Agustin; Togias, Alkis G.; Grindle, Kristine G.; Bochkov, Yury A.; Gruchalla, Rebecca S.; Kattan, Meyer; Kercsmar, Carolyn M.; Hershey, G. Khurana; Kim, Haejin; Lebeau, Petra; Liu, Andrew H.; Szefler, Stanley J.; Teach, Stephen J.; West, Joseph B.; Wildfire, Jeremy; Pongracic, Jaqueline A.; Gern, James E.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 196, No. 8, 15.10.2017, p. 985-992.

Research output: Contribution to journalArticle

Esquivel, A, Busse, WW, Calatroni, A, Togias, AG, Grindle, KG, Bochkov, YA, Gruchalla, RS, Kattan, M, Kercsmar, CM, Hershey, GK, Kim, H, Lebeau, P, Liu, AH, Szefler, SJ, Teach, SJ, West, JB, Wildfire, J, Pongracic, JA & Gern, JE 2017, 'Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma', American Journal of Respiratory and Critical Care Medicine, vol. 196, no. 8, pp. 985-992. https://doi.org/10.1164/rccm.201701-0120OC
Esquivel, Ann ; Busse, William W. ; Calatroni, Agustin ; Togias, Alkis G. ; Grindle, Kristine G. ; Bochkov, Yury A. ; Gruchalla, Rebecca S. ; Kattan, Meyer ; Kercsmar, Carolyn M. ; Hershey, G. Khurana ; Kim, Haejin ; Lebeau, Petra ; Liu, Andrew H. ; Szefler, Stanley J. ; Teach, Stephen J. ; West, Joseph B. ; Wildfire, Jeremy ; Pongracic, Jaqueline A. ; Gern, James E. / Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 196, No. 8. pp. 985-992.
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AU - Esquivel, Ann

AU - Busse, William W.

AU - Calatroni, Agustin

AU - Togias, Alkis G.

AU - Grindle, Kristine G.

AU - Bochkov, Yury A.

AU - Gruchalla, Rebecca S.

AU - Kattan, Meyer

AU - Kercsmar, Carolyn M.

AU - Hershey, G. Khurana

AU - Kim, Haejin

AU - Lebeau, Petra

AU - Liu, Andrew H.

AU - Szefler, Stanley J.

AU - Teach, Stephen J.

AU - West, Joseph B.

AU - Wildfire, Jeremy

AU - Pongracic, Jaqueline A.

AU - Gern, James E.

PY - 2017/10/15

Y1 - 2017/10/15

N2 - Rationale: Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal. Objectives: To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma. Methods: In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression. Measurements and Main Results: RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, 20.77 to 20.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84). Conclusions: In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility toRVinfections and illness.

AB - Rationale: Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal. Objectives: To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma. Methods: In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression. Measurements and Main Results: RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, 20.77 to 20.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84). Conclusions: In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility toRVinfections and illness.

KW - Asthma

KW - IgE

KW - Omalizumab

KW - Rhinovirus

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